Individual
AMANDA RENEE MACIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 305, FORT WAYNE, IN 46845-1715
(260) 266-8900
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28202704A
IN
363L00000X
Nurse Practitioner
Primary
71010563
IN
Other
Enumeration date
09/21/2020
Last updated
10/14/2022
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